title: Shoulder apprehension impacts large-scale functional brain networks.
abstract: OBJECTIVE
  Shoulder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. It remains unclear whether shoulder apprehension is the result of true recurrent instability or a memorized subjective sensation. We tested whether visual presentation of apprehension videos modifies functional brain networks associated with motor resistance and anxiety.
  
  
  METHODS
  This prospective study includes 15 consecutive right-handed male patients with shoulder apprehension (9 with right shoulder apprehension, 6 with left shoulder apprehension; 27.5 ± 6.4 years) and 10 healthy male right-handed age-matched control participants (29.0 ± 4.7 years). Multimodal MR imaging included 1) functional connectivity tensorial independent component analysis, 2) task-related general linear model analysis during visual stimulation of movies showing typical apprehension movements vs control videos, 3) voxel-based morphometry analysis of GM, and 4) tract-based spatial statistics analysis of WM.
  
  
  RESULTS
  Patients with shoulder apprehension had significant (P < .05 corrected) increase in task-correlated functional connectivity, notably in the bilateral primary sensory-motor area and dorsolateral prefrontal cortex and, to a lesser degree, the bilateral dorsomedial prefrontal cortex, anterior insula, and dorsal anterior cingulate cortex (+148% right, +144% left). Anticorrelated functional connectivity decreased in the higher-level visual and parietal areas (-185%). There were no potentially confounding structural changes in GM or WM.
  
  
  CONCLUSIONS
  Shoulder apprehension induces specific reorganization in apprehension-related functional connectivity of the primary sensory-motor areas (motor resistance), dorsolateral prefrontal cortex (cognitive control of motor behavior), and the dorsal anterior cingulate cortex/dorsomedial prefrontal cortex and anterior insula (anxiety and emotional regulation).
authors.affiliation: From the Departments of Imaging and Medical Informatics (S.H., J.H., K.-O.L.).
authors.forename: S
authors.initials: S
authors.lastname: Haller
authors.forename: G
authors.initials: G
authors.lastname: Cunningham
authors.forename: A
authors.initials: A
authors.lastname: Laedermann
authors.forename: J
authors.initials: J
authors.lastname: Hofmeister
authors.forename: D
authors.initials: D
authors.lastname: Van De Ville
authors.forename: K-O
authors.initials: KO
authors.lastname: Lovblad
authors.forename: P
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology* / Q000523:psychology; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009415:Nerve Net / Q000503:physiopathology*; D010775:Photic Stimulation / Q000379:methods; D017397:Prefrontal Cortex / Q000503:physiopathology; D011446:Prospective Studies; D066191:Sensorimotor Cortex / Q000503:physiopathology; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult